‘One-stop shop for TB, HIV clients’

TB, HIV co-infection is getting common as more people who get screened for tuberculosis also test HIV positive to HIV when tested.

In Zimbabwe, 70 percent of hospital admissions are due to the above.

The director in the Aids and TB Unit in the Ministry of Health and Child Care Dr Owen Mugurungi said that a large number of patients who seek treatment for tuberculosis, test HIV positive too.

“Most of our hospital admissions record tuberculosis and HIV co-infection as the cause of illness. A large number of tuberculosis patients up to 75 percent are also HIV positive when tested. So there is a co-relation, when one loses immunity, they get opportunistic infections and TB being one, it finds its way in one with a weak immune system. I am not saying HIV negative people do not get TB, they do, but the majority of TB patients are also HIV positive,” Dr Mugurungi said in Gweru at a workshop for Meaningful Involvement for People Living HIV.

On being asked by Shingirayi Matogo is there is a chance of repeat TB infection for one who had TB before, Dr Mugurungi said yes, there is a high probability of a person living HIV to get TB again.

“Yes there is a chance that one can get TB again. When successfully treated the TB becomes latent which means it lies inactive not making one ill. However, if a client on ART falls ill and gets the immune system falling again, there is a high chance that one can get a repeat attack of TB or any other opportunistic infection,” said Dr Mugurungi

Dr Mugurungi emphasized the need to have a one-stop service for TB, HIV co-infected patients.

“As the Ministry of Health, we have a goal of an integrated clinic where one seeking HIV services is also able to access TB treatment. We need to also provide sexual reproductive health rights to clients. The prevention-of-mother-to-child transmission of HIV should be accessible at all health centres under the same roof, on the same day and offered by the same health professional,” said Dr Mugurungi.

Integrating services will result in minimizing missed opportunities for anti retroviral therapy (ART) initiation, ensure client retention in care and enhances adherence on medication. For one needing treatment for the co-infection has had challenges as at times one has to visit two different centres.

There is a trend where people on ART are also reporting with other co-morbidities e.g. hypertension and diabetes. This needs also to be incorporated into the services of an ART patient in need of that.

An activist in the HIV sector, Mr Juao Zangaroti said clinics perform better as compared to big institutions when offering integrated services.

“Integration of services is usual functional at primary health care centres, the clinics in our communities. When visiting bigger hospitals, it becomes a challenge as one has to visit different departments, stand in a queue to be served and by the end of the day one is not able to access all the services in one day. So big institutions need to consolidate and train staff to be able to do that. If small clinics can do it, why not at central hospital level?” an activist Juao Zangaroti said.

“Visiting a local clinic sees a client get all the services in a day, in fact, in an hour or two. The problem is the big hospitals. For people in rural areas, distance then becomes a barrier because the health facility can be 10km away and to get there on time requires one to get onto a bus. We find that money is not easily available and so walking to such a facility is tiresome. Some people therefore walk in the end of the day to be able to get served in the next morning,” said Zangaroti.

Barriers to integrated services are seen across the health spectrum as we find a general lack of staff trained in all topics across different departments.

In order to see this hurdle passed, the integration and training has to be done at nursing schools. The curriculum has to ensure that all nurses have attended the integrated HIV prevention care and treatment training if we are to see the end of AIDS by 2030.

The communication and monitoring of inter-departments at referral hospitals has to be strengthened. The aim is that all nurses should be in a position to commence TB and ART treatment to all who require it.

A one-stop-service is the answer to saving time and lives as well as reduce the delay in initiating ART in co-infected clients.